Comparison between fast track and traditional protocols in total hip arthroplasty: risks and benefits

Abstract

Background: Hip osteoarthritis (HOA) is a progressive degenerative joint disease that significantly affects mobility, functionality, and quality of life. As global life expectancy increases, the prevalence of HOA is expected to rise, necessitating a comprehensive evaluation of management strategies, including biomechanical adaptations, conservative treatments, total hip arthroplasty (THA), and rehabilitation protocols. This systematic review synthesizes current evidence on the most effective therapeutic approaches for optimizing pain relief, functional mobility, and long-term patient outcomes. Methods: This study followed PRISMA guidelines for a systematic literature review. Searches were conducted in PubMed,

Scopus, Web of Science, and Cochrane Library, selecting peer- reviewed studies published between 2018 and 2024. Inclusion

criteria covered clinical trials, cohort studies, systematic reviews, and meta-analyses evaluating HOA management, THA techniques, and post-surgical rehabilitation. Quality assessments were

performed using the Cochrane Risk of Bias Tool, Newcastle- Ottawa Scale, and AMSTAR-2 checklist. Data were synthesized

using narrative synthesis and meta-analysis, where applicable. Results: Conservative treatments, particularly exercise therapy, weight management, and NSAID-based pharmacological

interventions, demonstrated significant efficacy in delaying disease progression and improving symptoms. Total hip arthroplasty remains the gold standard for end-stage HOA, with robotic-assisted THA, dual-mobility implants, and highly cross-linked polyethylene liners emerging as significant advancements in surgical precision and implant longevity. Postoperative rehabilitation, including proprioceptive training, gait retraining, and balance exercises, is essential for restoring function and minimizing complications. Biomechanical studies revealed that spinopelvic alignment, gait asymmetry, and altered joint offset play crucial roles in disease progression and surgical outcomes. Conclusion: Managing hip osteoarthritis requires a multimodal and individualized approach, integrating biomechanical assessments, conservative strategies, surgical innovations, and structured rehabilitation programs. Advances in artificial

intelligence-driven gait analysis, virtual rehabilitation, and 3D- printed implants offer promising future directions for optimizing

treatment. This review highlights the necessity of early diagnosis, biomechanical optimization, and evidence-based rehabilitation protocols to enhance patient mobility, independence, and overall quality of life.